Cycle Monitoring: What to Expect

Image courtesy of Functions of Cells and Human Body (

Image courtesy of Functions of Cells and Human Body (

When trying to conceive sometimes we find ourselves needing a little extra assistance. When deciding to get additional help from a fertility doctor, you can feel both relieved for potential answers and solutions, but also overwhelmed by trying to decipher what the hitch might be. Furthermore, with the multiple monthly visits and simply trying to reconcile that conception has moved from the bedroom to a clinic can be a process.

Cycle monitoring may be the only thing you need the clinic for, or it may be a part of further assistance that you require from the clinic, whatever the reason, if you've reached out to a fertility doctor you will likely be cycle monitored.

So what can you expect from cycle monitoring...?

Cycle monitoring allows your fertility doctor to find out exactly when you're ovulating to know when the best time to inseminate or have sex would be, and to increase the chances of a pregnancy. However, because everyone's cycle is different, it is hard to anticipate how often you'll need to visit the clinic, or when ovulation will occur.

When menstruation starts, so does your cycle monitoring schedule. You will need to visit the clinic on day two, three or four of your cycle, so your fertility doctor can review your blood work, how many follicles you have, and if one follicle is beginning to mature. At this visit your doctor will let you know when they would like to have you return which is usually somewhere between day 6 and 12 depending on the length of your cycle. After which, you will be asked to come back every two to three days until you get closer to ovulation, where you will then need to return on a daily basis until ovulation.

Each day that you're asked to visit the clinic, you'll need to get blood work done to monitor your hormone levels, have a trans-vaginal ultrasound to monitor your maturing follicle(s), and to meet with your fertility doctor to let you know when is best for you to return to be cycle monitored again.

Now what should you expect from your follicles?

During that first visit, or around day 2 - 5 of your cycle, your fertility doctor will be counting your ovarian reserve and is looking for between 6 - 10 follicles that will range between 2 - 10 mm in diameter. You should expect your follicle to grow 1 - 2 mm a day in size and when your dominant follicle reaches 20 - 24 mm, in combination with good hormone levels, this will indicate to your doctor that ovulation can happen with ease.

Lastly, what can you expect emotionally?

Cycle monitoring demands a lot more emotionally than physically, in particular when your follicle(s) are getting close to maturing and your fertility doctor would like you to return daily to keep an eye on that dominant follicle. Each clinic demands a different time commitment, some clinics schedule you in 15 min time slots, so you can be in and out (although you might end up with a time slot that doesn't work great in your schedule), while other clinics have you drop in between 7am and 9:30 am, so depending on how busy the clinic is you could be there for a couple of hours! Regardless of this the anticipation (or sometimes boredom) can be taxing. As you likely know, stress is not a friend of fertility. So what can you do:

  • Pack a Cycle Monitoring 'Survival Kit' including: if you're at a clinic that doesn't schedule visits, think about packing snacks, a good book, your computer to do work (this can decrease the stress of being away from work and keep you occupied), and your phone loaded with your favourite podcasts, audio books, or an audio meditation series.
  • If it's safe to do so, let your employer know, there will be times that you'll be late for work, and if your employer knows they'll likely be more flexible and accommodating with your schedule, which can help lower stress around time commitment.
  • It's so easy for us to want to keep conception on the down low to avoid unwanted questions and unsolicited advice. It is, however, worth letting in a close circle of friends that you can reach out to during those times you may be feeling overwhelmed or exhausted by the constant monitoring.
  • If you have a partner, a supportive friend, or a fertility doula, ask them to come with you if you need a little extra support or company on a particular day.
  • Often fertility clinics offer support groups for individuals or couples that are struggling with their fertility or need some assistance to get pregnant. They're not for everyone, but before you discount support groups, it is definitely worth inquiring if your clinic offers a support group.
  • Think about recruiting fertility practitioners outside of the fertility clinic such as a Naturopath, or acupuncturist, they are equipped with trade secrets that can help support and enhance the fertility treatments you're already receiving.

How cycle monitoring ends depends on what additional fertility assistance you require, whether it be simply help with timing, IUI or IVF.

I’m grateful that I’m getting help. But there are so many other things that I would rather do than be cycle monitored. It takes a bit of time to adjust being ‘on-call’ to your follicles.
— Client on Cycle Monitoring